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Vivek Verma, Amy C. Moreno, Waqar Haque, Penny Fang and Steven H. Lin

inclusion criterion for this study was newly diagnosed, primary NSCLC treated with upfront surgery followed by postoperative chemotherapy and RT. Patients who received neoadjuvant chemotherapy and/or RT were excluded. Surgery was defined as an oncologic

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Barbara Dull, Andrew Linkugel, Julie A. Margenthaler and Amy E. Cyr

, as well as results of fine-needle aspiration or biopsy, if performed. Patients who underwent neoadjuvant chemotherapy were excluded from this study because of inconsistencies in accurately determining stage at diagnosis. Patients with a recurrent

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Jill A. Foster, Maziar Abdolrasulnia, Hamidreza Doroodchi, Joan McClure and Linda Casebeer

Background

Studies of adherence to breast cancer guidelines have often focused on primary therapies, but concordance with other guideline recommendations has not been examined as extensively. This study assesses the knowledge and practice patterns of medical oncologists in the United States to inform education and quality improvement initiatives that can improve breast cancer care.

Methods

A survey containing case vignettes and related questions was developed to examine oncologists' clinical decision-making in evaluating and treating women with early breast cancer. The instrument was distributed to a random sample of 742 oncologists in the United States and yielded 205 responses (27.6% response rate). Responses from 184 practicing medical oncologists were analyzed relative to the 2007 NCCN Clinical Practice Guidelines in Oncology: Breast Cancer.

Results

Most oncologists made guideline-consistent choices in clarifying indeterminate human epidermal growth factor 2 (HER2) status (85%), initial treatment for early breast cancer (95%), and postsurgical management of locally advanced breast cancer (82%). Guideline-discordant choices were seen in the lack of clip placement before neoadjuvant chemotherapy (36%), unnecessary use of PET scanning for initial assessment (34%), inappropriate assessment of menopausal status (33%), inappropriate use of tumor markers (22%), and use of chest imaging (16%) during posttherapeutic surveillance.

Conclusions

Oncologists often make guideline-consistent choices, but discordant clinical decisions may occur in important aspects of care for early breast cancer. Broadening the diffusion and adoption of guideline recommendations is an important mechanism for addressing these gaps and may substantially improve the quality of breast cancer care.

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Charlotte E.L. Klaver, Lieke Gietelink, Willem A. Bemelman, Michel W.J.M. Wouters, Theo Wiggers, Rob A.E.M. Tollenaar, Pieter J. Tanis and on behalf of the Dutch Surgical Colorectal Audit Group

Background: The goal of this study was to evaluate current clinical practice and treatment outcomes regarding locally advanced colon cancer (LACC) at the population level. Methods: Data were used from the Dutch Surgical Colorectal Audit from 2009 to 2014. A total of 34,527 patients underwent resection for non-LACC and 6,918 for LACC, which was defined as cT4 and/or pT4 stage. LACC was divided into those with multivisceral resection (LACC-MV; n=3,385) and without (LACC-noMV; n=1,595). Guideline adherence, treatment strategy, and short-term outcomes were evaluated. Results: Guideline adherence was >90% regarding preoperative imaging and ≥80% regarding preoperative multidisciplinary team (MDT) discussion. In the elective setting, neoadjuvant chemoradiotherapy (chemoRT) was applied in 6.2% of the cT4 cases, and neoadjuvant chemotherapy in 4.0%. R0 resection rates were 99%, 91%, and 87% in patients with non-LACC, LACC-noMV, and LACC-MV, respectively (P<.001). A postoperative complicated course occurred in 17%, 25%, and 29% of patients (P<.001), and the 30-day/in-hospital mortality rate was 3.6%, 6.0%, and 5.4% (P<.001) in the non-LACC, LACC-noMV, and LACC-MV groups, respectively. Discussion/Conclusions: This population-based study suggests that there is room for improvement in the treatment of LACC, with regard to short-term surgical outcomes and oncologic outcomes (ie, radicality of resection). Improvement might be expected from optimized preoperative imaging, routine MDT discussions, and further specialization and centralization of care. Optimized use of neoadjuvant treatment strategies based on already available and upcoming evidence is likely to result in a better margin status and thereby a better long-term prognosis. Furthermore, lower R0 resection rates in an emergency setting suggest a potential role for bridging strategies in order to enable optimal staging, neoadjuvant treatment, and elective surgery by a surgical team most optimally qualified for the procedure.

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Scott M. Schuetze

for patients aged under 40 years with bone sarcoma in Britain, 1980–1994 . Br J Cancer 2006 ; 94 : 22 – 29 . 4. Bacci G Mercuri M Longhi A . Neoadjuvant chemotherapy for the treatment of osteosarcoma of the extremities: a comparison of

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Fei Gao, Nan Li, YongMei Xu and GuoWang Yang

recommended for patients with resected stage IIIA disease, including those with resected stage IIIA-N2 disease who can tolerate chemotherapy. 2 It is undeniable that preoperative neoadjuvant chemotherapy is applied to patients with IIIA-N2 disease, but in the

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With Residual Disease Post Standard Neoadjuvant Chemotherapy Principal investigator: Kimberly Blackwell, MD Sub-investigators: Sarah Sammons, MD; Paul Kelly Marcom, MD; Kelly Westbrook, MD; and Gretchen Kimmick, MD Condition: Breast cancer

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Peter E. Clark, Philippe E. Spiess, Neeraj Agarwal, Rick Bangs, Stephen A. Boorjian, Mark K. Buyyounouski, Jason A. Efstathiou, Thomas W. Flaig, Terence Friedlander, Richard E. Greenberg, Khurshid A. Guru, Noah Hahn, Harry W. Herr, Christopher Hoimes, Brant A. Inman, A. Karim Kader, Adam S. Kibel, Timothy M. Kuzel, Subodh M. Lele, Joshua J. Meeks, Jeff Michalski, Jeffrey S. Montgomery, Lance C. Pagliaro, Sumanta K. Pal, Anthony Patterson, Daniel Petrylak, Elizabeth R. Plimack, Kamal S. Pohar, Michael P. Porter, Wade J. Sexton, Arlene O. Siefker-Radtke, Guru Sonpavde, Jonathan Tward, Geoffrey Wile, Mary A. Dwyer and Courtney Smith

Perioperative Chemotherapy One of the most noteworthy issues in the treatment of bladder cancer is the optimal use of perioperative chemotherapy for muscle-invasive disease. Data support the role of neoadjuvant chemotherapy before cystectomy for T2, T3, and T4

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284 0060277 10.6004/jnccn.2008.0023 Neoadjuvant Chemotherapy in Stage III NSCLC Allen Jeffrey MD Jahanzeb Mohammad MD Robinson Kerrin G. MA 03 2008 6 6 3 3 285 285 293 293 0060285 10.6004/jnccn.2008.0024 Small Cell Lung Cancer

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Julie R. Heitz, Mintcho E. Mintchev and Joseph W. Howells

the EWSR1 locus at 22q12. She underwent gastrojejunostomy which relieved her obstructive symptoms, but was complicated by persistent bleeding from her ulcerative mass. Radiation therapy led to resolution of her bleeding and neoadjuvant chemotherapy